Patient data mining for cardiology screening

ABSTRACT

A system and method for screening for coronary heart disease is provided. The method includes the steps of retrieving a test for assessing risk of coronary heart disease, the test including a plurality of data fields relating to coronary risk factors; accessing a database to populate the data fields with information of an individual patient; and calculating a risk assessment of the individual patient developing coronary heart disease. A system includes a first database including a plurality of structured computerized patient records; a second database including a knowledge base relating to coronary heart disease, the second database including at least one test for determining coronary heart disease risk; and a processor for retrieving the at least one test from the second database, populating the at least one test with patient information retrieved from the first database and calculating a risk assessment for at least one patient.

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. ProvisionalApplication Ser. No. 60/335,542, filed on Nov. 2, 2001, which isincorporated by reference herein in its entirety.

FIELD OF THE INVENTION

[0002] The present invention relates to medical information processingsystems, and, more particularly to a computerized system and method forscreening patients for coronary heart disease (CHD), assessing a riskfactor for a person to develop CHD and managing a person with CHD.

BACKGROUND OF THE INVENTION

[0003] Coronary heart disease is the number one killer in the westernworld. By detecting coronary heart disease as early as possible,appropriate, effective, and cost-effective treatment can be implemented.

[0004] However, cardiologists are faced with an ever-growing amount ofdata coming from a variety of different sources: imaging modalities,patient reports, ECG tracings, etc. As the number of information sourcesexpand, extracting and assimilating all available data manually, andassessing various treatment options, becomes more and more difficult.Furthermore, with the push from managed care, cardiologists are expectedto treat and manage more patients in the same amount of time.

[0005] Currently, there is considerable evidence that cardiovascularrisk and disease is under-treated. Factors that account for this includegaps in knowledge, confusion over recommendations including targetlevels for lipids during treatment, poor doctor-patient communication,and variations in physician understanding and utilization of guidelines.

[0006] In view of the above, there exists a need for improved systemsand methods for screening persons for coronary heart disease, assessingthe risks of individuals patients in developing coronary heart disease,and managing patients with coronary heart disease.

SUMMARY OF THE INVENTION

[0007] A system and method for screening, detecting and managingpatients with coronary heart disease (CHD) is provided.

[0008] According to one aspect of the present invention, a method forscreening for coronary heart disease is provided including the steps ofretrieving a test for assessing risk of coronary heart disease, the testincluding a plurality of data fields relating to coronary risk factors;accessing a database to populate the data fields of the test withpatient information of an individual patient, the database includingcomputerized patient records; and calculating a risk assessment of theindividual patient developing coronary heart disease. The method furtherincludes the steps of data mining information relating to the coronaryrisk factors from structured and unstructured data sources; andcompiling the information as a structured com

[0009] According to another aspect of the present invention, a coronaryheart disease screening system includes a first database including aplurality of structured computerized patient records; a second databaseincluding a knowledge base relating to coronary heart disease, thesecond database including at least one test for determining coronaryheart disease risk wherein the at least one test includes a plurality ofdata fields relating to coronary risk factors; and a processor forretrieving the at least one test from the second database, populatingthe data fields of the at least one test with patient informationretrieved from the first database and calculating a risk assessment forat least one patient. The first database is compiled by data mininginformation relating to the coronary risk factors from structured andunstructured data sources.

[0010] According to a further aspect of the present invention, a programstorage device readable by a machine, tangibly embodying a program ofinstructions executable by the machine to perform method steps forscreening for coronary heart disease is provided. The method stepsinclude retrieving a test for assessing risk of coronary heart disease,the test including a plurality of data fields relating to coronary riskfactors; accessing a database to populate the data fields of the testwith patient information of an individual patient, the databaseincluding computerized patient records; and calculating a riskassessment of the individual patient developing coronary heart disease.

BRIEF DESCRIPTION OF THE DRAWINGS

[0011] The above and other aspects, features and advantages of thepresent invention will become more apparent from the following detaileddescription when taken in conjunction with the accompanying drawings inwhich:

[0012]FIG. 1 is a block diagram of a computer processing system to whichthe present invention may be applied according to an embodiment of thepresent invention;

[0013]FIG. 2 illustrates an exemplary coronary heart disease screeningsystem according to an embodiment of the present invention; and

[0014]FIG. 3 illustrates a flow diagram for screening, monitoring andmanaging a patient according to an embodiment of the present invention.

DESCRIPTION OF PREFERRED EMBODIMENTS

[0015] To facilitate a clear understanding of the present invention,illustrative examples are provided herein which describe certain aspectsof the invention. However, it is to be appreciated that theseillustrations are not meant to limit the scope of the invention, and areprovided herein to illustrate certain concepts associated with theinvention.

[0016] A system and method for screening, detecting and managingpatients for coronary heart disease (CHD) is provided. According to anembodiment of the present invention, a computer-based coronary heartdisease screening system will aid a physician in the assessment andmanagement of coronary heart disease. First, the system will assimilateinformation from both imaging and non-imaging sources within acomputerized patient record (CPR). These data can be automaticallyextracted, combined, an analyzed in a meaningful way, and the resultspresented to the physician. Such a system will also help avoid mistakes,as well as provide a novice with knowledge “captured” from expert usersbased on a domain knowledge base of a disease of interest andestablished clinical guidelines. Within each specific diagnostic test,the system will assist in automatically extracting information resultingin potential improvements to workflow as well as providing a powerful“second reader” in the evaluation of the results. Following evaluation,the system will also provide suggested therapies and follow-ups based onclinical guidelines. Finally, the system could track the patient overtime, assessing the progress of the disease and the efficacy of therapy.

[0017] In the area of coronary artery disease, the world can be dividedinto two groups: those with known or suspected coronary artery disease,and those without. In the latter case, the key is to promote preventionand decrease the risk of coronary artery events. Here, the coronaryheart disease screening system is targeted to the clinical cardiologist,and the general practitioner, to help assess, monitor, and reduce therisk of coronary heart disease.

[0018] In the case of people with known or suspected coronary heartdisease, the role of a computer-aided coronary heart disease screeningsystem is slightly different. First, such a system could aid in theassessment and diagnosis of the disease by the physician. Next, thesystem could help a cardiologist assess the severity of the disease, andhelp identify potential therapies. Finally, the system could assist withassessing the progression or regression of the disease either over timeor in response to therapy.

[0019] It is to be understood that the present invention may beimplemented in various forms of hardware, software, firmware, specialpurpose processors, or a combination thereof. Preferably, the presentinvention is implemented in software as a program tangibly embodied on aprogram storage device. The program may be uploaded to, and executed by,a machine comprising any suitable architecture. Preferably, the machineis implemented on a computer platform having hardware such as one ormore central processing units (CPU), a random access memory (RAM), andinput/output (110) interface(s). The computer platform also includes anoperating system and microinstruction code. The various processes andfunctions described herein may either be part of the microinstructioncode or part of the program (or combination thereof) which is executedvia the operating system. In addition, various other peripheral devicesmay be connected to the computer platform such as an additional datastorage device and a printing device.

[0020] It is to be understood that, because some of the, constituentsystem components and method steps depicted in the accompanying figuresare preferably implemented in software, the actual connections betweenthe system components (or the process steps) may differ depending uponthe manner in which the present invention is programmed.

[0021]FIG. 1 is a block diagram of a computer processing system 100 towhich the present invention may be applied according to an embodiment ofthe present invention. The system 100 includes at least one processor(hereinafter processor) 102 operatively coupled to other components viaa system bus 104. A read-only memory (ROM) 106, a random access memory(RAM) 108, an I/O interface 110, a network interface 112, and externalstorage 114 are operatively coupled to the system bus 104. Variousperipheral devices such as, for example, a display device, a diskstorage device (e.g., a magnetic or optical disk storage device), akeyboard, and a mouse, may be operatively coupled to the system bus 104by the I/O interface 110 or the network interface 112.

[0022] The computer system 100 may be a standalone system or be linkedto a network via the network interface 112. The network interface 112may be a hard-wired interface. However, in various exemplaryembodiments, the network interface 112 can include any device suitableto transmit information to and from another device, such as a universalasynchronous receiver/transmitter (UART), a parallel digital interface,a software interface or any combination of known or later developedsoftware and hardware. The network interface may be linked to varioustypes of networks, including a local area network (LAN), a wide areanetwork (WAN), an intranet, a virtual private network (VPN), and theInternet.

[0023] The external storage 114 may be implemented using a databasemanagement system (DBMS) managed by the processor 102 and residing on amemory such as a hard disk. However, it should be appreciated that theexternal storage 114 may be implemented on one or more additionalcomputer systems. For example, the external storage 114 may include adata warehouse system residing on a separate computer system.

[0024] Those skilled in the art will appreciate that other alternativecomputing environments may be used without departing from the spirit andscope of the present invention.

[0025] Referring to FIG. 2, an exemplary coronary heart disease (CHD)screening system 200 according to an embodiment of the present inventionis illustrated. The CHD screening system 200 includes a processor 202which processes a plurality of modules for performing different tasks.The processor is coupled to a first database 204 compiled to store aplurality of structured computerized patient records (CPR) relating to adisease of interest, here, coronary heart disease.

[0026] Preferably, the structured database 204 is populated withpopulation-based patient information using data mining techniquesdescribed in “Patient Data Mining,” by Rao et al., copending U.S. patentapplication Ser. No. 10/______,______, (Attorney Docket No.8706-600)filed herewith, which is incorporated by reference herein in itsentirety. That patent application teaches a data mining framework formining high-quality structured clinical information. The data miningframework includes a data miner 206, having functions and capabilitiesas in the REMIND system, commercially available from Siemens MedicalSolutions, that mines medical information from computerized patientrecords (CPRs) based on domain-specific knowledge contained in aknowledge base. The CPRs may be of structured 208 (e.g., chart, tables,billing information, etc.) and/or unstructured formats 210 (e.g.,doctors' dictations, images such as MR (magnetic resonance) images andCT (computerized tomography)scans, ECG waveforms, etc.). Thedomain-specific knowledge may relate to a disease of interest, ahospital, etc. The data miner 206 includes components for extractinginformation from the CPRs, combining all available evidence in aprincipled fashion over time, and drawing inferences from thiscombination process. The mined medical information is stored in thestructured CPR database, such as database 204.

[0027] The processor 202 is further coupled to a second database 212including state of the art information relating to the disease ofinterest. This information may include standard procedures, establishedguidelines for treatment, standardized tests for assessment anddiagnosis, etc.

[0028] Additionally, the processor 202 is adapted to receive manuallyinputted patient data 214 which it will process and store in the firststructured database 204.

[0029] The CHD screening system 200 interacts with the first structureddatabase 204 and the medical knowledge database 212 to assess the riskof a patient developing CHD, to recommend therapies and lifestylechanges to reduce the patient's assessed risk, and to performsensitivity analysis to determine what factors are of the greatest riskto a patient. Each task performed by the CHD screening system 200 isperformed by an executable module residing either in the processor ofthe system 202 and/or in a memory device (e.g., RAM, ROM, externalstorage, etc.) of the system.

[0030] Referring to FIGS. 2 and 3, the CHD screening system will befurther described along with methods for assessing CHD risk, monitoringCHD patients and suggesting therapies and lifestyle changes.

[0031] The goal of both primary and secondary CHD prevention is todecrease the risk of subsequent acute coronary events, and therebydecrease mortality and prolong survival. In primary prevention, the ideais to identify healthy (asymptomatic) individuals at high risk ofdeveloping coronary artery disease, and initiate therapies and lifestylechanges to lower this risk. Secondary prevention does the same forpeople who have had an acute coronary event. The system and method ofthe present invention will assist physicians and play a significant rolein assessment of risk, targeted suggestions for therapy and lifestylechanges based on established guidelines, and monitoring patient progresstowards goals of risk reduction.

[0032] In primary prevention, asymptomatic individuals at high risk ofdeveloping coronary artery disease are identified, and therapiesinitiated and lifestyle changes recommended to lower this risk. First,asymptomatic patients are assessed for risk for coronary heart diseaseon the basis of risk factors. For example, the National CholesterolEducation Program (NCEP) has recently produced a set of Adult TreatmentPanel (ATP III) guidelines for the treatment and management of lipiddisorders. In these guidelines, the risk of an acute coronary event overa 10-year period for people with no history of coronary heart disease iscalculated based on a modified version of the Framingham algorithm ortest. The Framingham algorithm uses traditional risk factors, such asgender, obesity, smoking, total cholesterol, HDL-cholesterol, age,diabetes, and blood pressure, to determine overall risk. The ATP IIIguidelines also include other risk factors, such as family history andhypertension, in its risk model. In addition to these traditional riskfactors, the guideline acknowledges emerging risk factors, such ashemocysteine, lipoprotein(a), and inflammatory markers such as highsensitivity C-reactive proteins which can indicate risk of acutecoronary events. In addition, the NCEP ATP III has developed specificrecommendations for therapy and lifestyle changes based on these riskfactors for both primary and secondary prevention. Such tests,recommendations and guidelines will be stored in the medical knowledgedatabase 212.

[0033] These guidelines serve to help the clinical cardiologist, as wellas the patient's primary-care physician, assess the risk and helpprevent the incidence of an acute coronary artery event. In thissituation, the CHD screening system 200 could provide valuableassistance in a variety of different ways. First, the assessment of riskrequires obtaining clinical information contained in a variety ofdifferent locations within a patient's record. Structured 208 andunstructured 210 data are mined via the data miner 206 and stored instructured CPR in database 204 (step 302). The system 200 then accessedthe second database 212 to retrieve a test, such as the Framinghamalgorithm, to assess the risk of an individual patient (step 304). Anassessment module 202-1 receives the test and populates a plurality ofdata fields within the test with information retrieved from thestructured database 204 and calculates the risk for the patient (step306). Depending on the risk assessment or score, the patient iscategorized as being a low risk (step 308), intermediate risk (310) orhigh risk (step 312).

[0034] It is to be appreciated that all the information necessary tocalculate the risk assessment may not be readily available from thepatient record. If the information is missing, the system will mineavailable data to make a probabilistic assertion regarding the missinginformation. The system will then calculate the patient's riskassessment with the probabilistic information.

[0035] It is to be appreciated that the ability to automaticallyretrieve information and calculate these risks would save the physiciantime, and would enable automated screening of a very large population.Incomplete or conflicting information could be brought to the attentionof the physician.

[0036] Once the risk is assessed for an individual patient, a specificset of recommended tests, therapies and/or lifestyle changes, targetedto the patient and based on specific adopted guidelines, will beautomatically generated (step 316). Upon subsequent screening visits bythe patient, the CHD system 200 will track recommendations againstpatient performance via a patient management module 202-2. For example,the patient's cholesterol levels and lifestyle changes in subsequentcheck-ups could be matched against guideline targets and previouslyrecorded levels, and follow-up reports automatically generated for thephysician. The patient management module may periodically reassess therisk of the patient and alert the appropriate personnel if a significantchange is detected. Additionally, the patient management module mayrecommend a time for a reassessment due to the length of time betweenassessments and or tests.

[0037] In addition to assessing current risk, the CHD system 200 willperform sensitivity analysis on the various risk factors to assess theimportance of each individual risk factor on that patient via asensitivity module 202-3. That is, for each risk factor, the system willweigh its individual importance in assigning the overall risk of acutecoronary events to the individual. First, a model is created to simulatea patient with similar characteristics of the patient being tested (step320). A modeling module 202-4 generates the model either by simulating asimilar patient based on the data stored in the medical knowledgedatabase 212 or by mining data of similar patients from population-baseddata sources via the data miner 206 using a domain knowledge base of thedisease of interest (i.e., coronary heart disease; alternatively, themodel could be a combination of both. The sensitivity module 202-3 theninteracts with the modeling module 202-4 by varying input data tosimulate different scenarios to determine which factor most influencesthe risk assessment of the patient (step 322).

[0038] The sensitivity analysis is important for several reasons. First,for many patients, not all of the risk factors are usually tested. Forexample, one of the risk factors is the presence of diabetes. However,not all patients have had a blood-sugar test done. In this case, therisk of heart disease is first assessed without this information. Then,an analysis is done with different blood-sugar results to see whetherthe risk assessment outcome changes. If the change is significant, thesystem may recommend that a blood-sugar test be done to refine thecardiac risk for the patient. Secondly, the sensitivity analysis willassess when the patient needs to come back for another screening, andwhat exams should be performed (step 316). For example, it is known thatblood pressure can change significantly from reading to reading, and itcan also slowly go up or down over time. By knowing the typicalvariability of such a variable, the system can help decide when thepatient needs to come back for another blood pressure reading byassessing what type of change would result in a significant change inrisk assessment.

[0039] Additionally, the system 200 will recommend whether further riskstratification is needed. If the initial risk assessment shows that aperson has a low risk of acute coronary events (step 308), then aphysician may recommend a healthy lifestyle with diet and exercise (step316). Conversely, if the assessment shows a high risk of acute coronaryevent (step 312), then a physician may decide on some kind of therapy(316), such as aspirin or cholesterol-reducing drugs, based on clinicalguidelines. However, some people will show an intermediate risk of heartdisease (step 310). In these cases, there may be a need to furtherassess and refine the risk of coronary heart disease in a patient (step314).

[0040] Where further risk stratification is needed, a number ofdifferent techniques can be used, and the choice of a technique maydepend on the cardiologist's experience, comfort level, and access toequipment. Many of the techniques developed to further stratify risk doso by measuring artherosclerotic burden, for example, (1) measurement ofankle/brachial blood pressure index (ABI); (2) measurement ofhemocysteine, lipoprotein(a), and inflammatory markers such as highsensitivity C-reactive proteins, as well as other emerging biochemicalmarkers; (3) measurement of intima-media thickness (IMT) from thecarotid arteries using high-frequency B-mode ultrasound; (4) assessmentof plaques in coronary arteries using Electron-beam Computed Tomography(EBCT); (5) assessment of composition of artherosclerotic plaque withmagnetic resonance imaging (MRI); (6) assessment of endothelial functionto determine artherosclerotic risk; and (7) scoring coronary calcium,e.g., using the Agatston score.

[0041] To facilitate the risk stratification, the system 200 may furtherinclude an imaging module 202-5 to automatically extract informationfrom the imaging sources mentioned above (e.g., by conventional imagesegmentation methods), and combine the extracted information with thepreviously assessed risk to reassess the overall risk of the patient.The results of any risk stratification could be used to generatepatient-directed recommendations based on established clinicalguidelines using this additional risk assessment (step 316).

[0042] Implementation of the CHD system for secondary prevention is asimpler than for primary prevention. The reason is that once a patienthas had an acute coronary event, they will always be at high-risk for asubsequent event. Therefore, there is little need for risk assessment inthese individuals. Rather, the main emphasis in secondary prevention isto create a specific set of recommended therapies and lifestyle changes,targeted to the patient and based on specific adopted guidelines.

[0043] Goals for lifestyle changes as well as lipid management and bloodpressure have been established for primary and secondary prevention. Bytracking a patient over time (step 318), the system could automaticallyassess whether the patient is achieving the desired goals for riskreduction, and whether changes need to be implemented either in thetherapy or implementation. The effects of specific diet changes,exercise, or cholesterol-lowering drugs, for example, can be feedbackinto the system to redesign therapies and create new recommendations forindividual patients. Conventionally, tracking patients require manualmonitoring of patient information, and comparing against establishedstandards. These manual monitoring techniques have resulted ininconsistent management of cardiovascular risk.

[0044] Furthermore, the CHD system can be used to assist in diagnosis ofa patient with CHD. Often times, the first time a patient is referred toa cardiologist is after coronary artery disease has significantlyprogressed, and the patient exhibits some symptoms. For this group ofpeople, it is important to be able to diagnose the disease, and thenapply appropriate therapy and monitor their progress in a rapid manner.The diagnosis may be performed combining all available information aboutthe patient and perform a probabilistic inference on patient-specificissues based on the domain knowledge base using techniques described in“Patient Data Mining for Diagnosis and Projections of Patient States,”by Rao et al., copending U.S. patent application Ser. No.10/______,______, (Attorney Docket No. 8706-624) filed herewith, whichis incorporated by reference herein in its entirety.

[0045] For example, in an emergency room, patients may present withchest pain. The emergency room physician must be able to diagnose acutecoronary events, and may need to initiate therapies to stabilize thepatient. According to ACC/AHA guidelines, electrocardiography (ECG) isthe procedure of first choice in patients presenting with chest pain,dizziness or syncope—symptoms that may be predictive of sudden death ormyocardial infarction. In situations where the ECG is non-diagnostic,ultrasound can be used to assess regional systolic wall motionabnormalities. Since the emergency room physician may not be asexperienced as a cardiologist to interpret these tests, the CHD systemcan provide a checklist of items to assist with diagnosis, and thenautomatically extract information from sources, such as the ECG orultrasound exams, to assist in rapid determination of an acute coronaryevent. In addition, the system could provide suggested immediatetherapies based on established clinical guidelines.

[0046] Furthermore, the CHD system could aid a clinical cardiologist inanswering important clinical questions, including: diagnosis ofobstructive coronary heart disease; assessment of severity of diseaseand complications; assessment of viability of diseased heart tissue; andrecommendations for patient management based on established clinicalguidelines.

[0047] A number of diagnostic tools are at the cardiologist's disposalto help answer these questions, e.g., electrocardiography, coronaryangiography, radionuclide imaging, ultrasound, magnetic resonanceimaging, electron-beam computed tomography, etc. Each of thesemodalities measures either direct or surrogate indicators of coronaryartery disease. Individually, each can help provide evidence of coronaryartery disease. The choice of diagnostic tool used by the cardiologistis often made based on availability, experience, and comfort level. Eachmodality measures something slightly different in assessing coronaryartery disease. Potentially more powerful, therefore, is theregistration of data from different sources to provide a more completepicture in assessing coronary artery disease. Currently, diagnosis ofcoronary artery disease is often done using a qualitative, orsemi-quantitative, approach. As a result, the effectiveness of suchdiagnostic approaches depends to a great extent on the experience andknowledge of the doctor. For example, stress echocardiography forassessment for global function and regional abnormalities is done usinga visual inspection followed by point scoring.

[0048] The CHD system will extract and combine information in aquantitative manner from a variety of different sources to help theclinical cardiologist address these clinical questions, augmenting thephysician's own intuition and experience. In this manner, the systemwould assist the physician in their own decision-making process,following accepted guidelines and practices.

[0049] In addition to detecting coronary artery disease, a number ofimaging modalities can be used to assess the progression or regressionof the disease either over time or in response to therapy. Some of theseinclude ultrasound, coronary angiography, radionuclide imaging, andintravascular ultrasound. Many times, these techniques are used to studythe effects of specific therapy, such as revascularization. In anotherscenario, these techniques could be used to monitor the progression orregression of a patient over time to assess when and if intervention isnecessary.

[0050] The CHD system will extract information from the images produced,e.g., by segmentation, volume rendering, etc., and register theinformation on a patient from different points of time and fromdifferent sources, to assess the progression or regression of disease.By creating such an automatic system, physicians can more easily monitorthe progression or regression of coronary artery disease, which canassist in deciding the efficacy of a particular plan of treatment.

[0051] In the area of coronary artery disease, the systems and methodsof the present invention can potentially play a large role in the totalmanagement of a patient, including prevention, detection, therapy, andmonitoring. Today, information about the patient comes a wide variety ofdifferent sources, including patient clinical history, waveform datasuch as ECG, imaging data, blood tests, etc. Furthermore, numerousclinical guidelines are established by bodies such as the ACC, AHA, andESC to discuss issues such as prevention, detection, and therapy. Thesystem and method of the present invention can assist physicians byautomatically collecting information from a wide variety of differentsources and analyzing them. Information can be presented to thephysician along with suggestions based on established clinicalguidelines.

[0052] It is to be appreciated that various embodiments of the presentinvention are to be defined in the context of the physician's workflow.Such embodiments could exist as a distributed system within differentsub-systems as defined by clinical workflow and usefulness. For example,some components may fit within the imaging modality, such as on theultrasound system or on an MRI console system. Other pieces orcomponents may reside on a review workstation, like a KinetDx® orLeonardo™ workstation. A comprehensive system may belong on a Sorian™cardiology system. Together, they will form a united clinical solution.Alternatively, such a system could exist as a remote server resulting inan ASP(Application Service Provider)-model solution. This could allowsmall systems, such as hand-held ultrasound systems and other hand-helddevices (e.g., personal digital assistants, handheld computers, laptopcomputers, etc.) to leverage the CHD system at a remote site, in anemergency room or at the scene of an incident outside the hospital.

[0053] Although illustrative embodiments of the present invention havebeen described herein with reference to the accompanying drawings, it isto be understood that the invention is not limited to those preciseembodiments, and that various other changes and modifications may beaffected therein by one skilled in the art without departing from thescope or spirit of the invention.

What is claimed is:
 1. A method for screening for coronary heartdisease, the method comprising the steps of: retrieving a test forassessing risk of coronary heart disease, the test including a pluralityof data fields relating to coronary risk factors; accessing a databaseto populate the data fields of the test with patient information of anindividual patient, the database including computerized patient records;and calculating a risk assessment of the individual patient developingcoronary heart disease.
 2. The method as in claim 1, where the test is amodified Framingham algorithm.
 3. The method as in claim 1, wherein thecoronary risk factors include one or more of gender, obesity, smoking,total cholesterol, HDL-cholesterol, age, diabetes, blood pressure,family history, hypertension, hemocysteine, lipoprotein(a), andinflammatory markers.
 4. The method as in claim 1, further comprisingthe steps of: data mining information relating to the coronary riskfactors from structured and unstructured data sources; and compiling theinformation as a structured computerized patient record in the database.5. The method as in claim 1, further comprising the steps of determiningwhether the individual patient has a low risk, intermediate risk or highrisk of developing coronary heart disease based on the calculated riskassessment.
 6. The method as in claim 5, wherein after the risk ofcoronary heart disease is determined further comprising the step offurther stratifying the risk assessment using additional risk factors.7. The method as in claim 6, where the additional risk factors measureartherosclerotic burden of the individual patient.
 8. The method as inclaim 7, wherein the measure of artherosclerotic burden includemeasurement of ankle/brachial blood pressure index (ABI), measurement ofintima-media thickness (IMT), assessment of plaques in coronaryarteries, assessment of composition of artherosclerotic plaque,assessment of endothelial function, and scoring coronary calcium.
 9. Themethod as in claim 1, further comprising the step of recommendinglifestyle changes to the individual patient based on the calculated riskassessment.
 10. The method as in claim 9, further comprising the stepsof tracking the patient information over a period of time andrecalculating the risk assessment of the individual patient.
 11. Themethod as in claim 1, further comprising the step of recommendingtherapies to the individual patient based on the calculated riskassessment.
 12. The method as in claim 11, further comprising the stepsof tracking the patient information over a period of time andrecalculating the risk assessment of the individual patient.
 13. Themethod as in claim 1, further comprising the step of performing asensitivity analysis on the coronary risk factors of the individualpatient to determine which factor will have the greatest effect ininfluencing the risk assessment.
 14. The method as in claim 13, furthercomprising the step of creating a model of a coronary heart diseasepatient to simulate effects of different variables to perform thesensitivity analysis.
 15. The method as in claim 14, wherein the modelis based on medical knowledge of a disease of interest.
 16. The methodas in claim 15, wherein the model is based on information mined frompopulation-based data sources of patients exhibiting coronary heartdisease.
 17. The method as in claim 1, further comprising the step ofdetermining a time for follow-up assessment based on the calculatedassessment.
 18. The method as in claim 1, further comprising the stepsof: determining if at least one of the plurality of data fields is notpopulated; and recommending a test to be conducted to populate the atleast one data field.
 19. The method as in claim 1, further comprisingthe steps of determining if at least one of the plurality of data fieldsis not populated; and estimating information for the data fieldprobabilistically.
 20. The method as in claim 13, further comprising thestep of determining a time for a follow-up assessment based on thedetermined risk factor.
 21. The method as in claim 13, furthercomprising the steps of: determining if at least one of the plurality ofdata fields is not populated; and recommending a test to be conducted ifthe at least one data field is the determined risk factor.
 22. Acoronary heart disease screening system comprising: a first databaseincluding a plurality of structured computerized patient records; asecond database including a knowledge base relating to coronary heartdisease, the second database including at least one test for determiningcoronary heart disease risk wherein the at least one test includes aplurality of data fields relating to coronary risk factors; and aprocessor for retrieving the at least one test from the second database,populating the data fields of the at least one test with patientinformation retrieved from the first database and calculating a riskassessment for at least one patient.
 23. The system as in claim 22,wherein the first database is compiled by data mining informationrelating to the coronary risk factors from structured and unstructureddata sources.
 24. The system as in claim 22, further comprising anassessment module for determining whether the at least one patient has alow risk, intermediate risk or high risk of developing coronary heartdisease based on the calculated risk assessment.
 25. The system as inclaim 24, wherein if the individual patient is determined to be anintermediate risk, the processor is adapted to stratify the riskassessment by data mining information measuring artherosclerotic burdenfrom the structured computerized patient record of the at least onepatient.
 26. The system as in claim 22, further comprising a patientmanagement module for recommending lifestyle changes to the at least onepatient based on the calculated risk assessment.
 27. The system as inclaim 26, wherein the patient management module tracks the at least onepatient over a period of time and recalculates the risk assessment ofthe at least one patient.
 28. The system as in claim 22, furthercomprising a patient management module for recommending therapies to theat least one patient based on the calculated risk assessment.
 29. Thesystem as in claim 28, wherein the patient management module tracks theat least one patient over a period of time and recalculating the riskassessment of the at least one patient.
 30. The system as in claim 22,further comprising a sensitivity module for analyzing the coronary risksfactors of the at least one patient to determine which factor will havethe greatest effect in influencing the risk assessment.
 31. The systemas in claim 30, further comprising a modeling module for generating amodel of a coronary heart disease patient to simulate effects ofdifferent variables, the model being employed by the sensitivity module.32. The system as in claim 22, further comprising an imaging module forextracting patient information from images and storing the patientinformation in the structured computerized patient record.
 33. Thesystem as in claim 22, wherein the processor determines a time for afollow-up assessment based on the calculated assessment.
 34. The systemas in claim 22, wherein the processor determines if at least one of theplurality of data fields is not populated and recommends a test to beconducted to populate the at least one data field.
 35. The system as inclaim 30, wherein the processor determines a time for a follow-upassessment based on the determined risk factor.
 36. The system as inclaim 30, wherein the processor determines if at least one of theplurality of data fields is not populated and recommends a test to beconducted if the at least one data field is the determined risk factor.37. The system as in claim 22, wherein at least one of the plurality ofstructured patient records include information obtained from miningunstructured data.
 38. The system of claim 22, wherein the plurality ofstructured patient records include probabilistic information.
 39. Thesystems of claim 22, wherein all the patient information needed tocalculate the risk assessment is not included in the plurality ofstructured patient records.
 40. The system of claim 39, wherein missinginformation is mined probabilistically and the risk assessment isadjusted to include the probabilistic patient information in the riskassessment.
 41. The system of claim 40, wherein the risk assessment iscomputed automatically at periodic intervals from the patient record.42. The system of claim 41, wherein the processor notifies if there is asignificant change in the patient's risk assessment.
 43. The system ofclaim 42, wherein the processor notifies if sufficient time has lapsedsuch that it is possible the patient's risk assessment has significantlychanged.
 44. A program storage device readable by a machine, tangiblyembodying a program of instructions executable by the machine to performmethod steps for screening for coronary heart disease, the method stepscomprising: retrieving a test for assessing risk of coronary heartdisease, the test including a plurality of data fields relating tocoronary risk factors; accessing a database to populate the data fieldsof the test with patient information of an individual patient, thedatabase including computerized patient records; and calculating a riskassessment of the individual patient developing coronary heart disease.